Antiarrhythmic and nonantiarrhythmic drugs for sudden cardiac death prevention

Mithilesh Das, Douglas P. Zipes

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Life-threatening ventricular arrhythmias such as sustained ventricular tachycardia and ventricular fibrillation are responsible for two thirds of sudden cardiac deaths annually in the United States. Implantable cardioverter-defibrillator (ICD) therapy prevents mortality from arrhythmic death but is expensive and has some associated morbidity from proarrhythmia and mechanical malfunction. Furthermore, ICDs treat ventricular arrhythmias but do not prevent them. Antiarrhythmic drugs (AADs) can be used for acute or chronic therapy to prevent ventricular arrhythmias and sudden cardiac deaths. AADS are often used in patients with an ICD who have recurrent ICD shocks resulting from ventricular arrhythmias. Class I AADs are contraindicated in patients with structural heart disease. Other than amiodarone, all Class III drugs have either a neutral or deleterious effect on mortality. Dronedarone, a new Class III drug, may reduce mortality, but more information is needed to be sure. A class of drugs that do not qualify as an AAD can modify cardiovascular remodeling processes and have a delayed and indirect antiarrhythmic effect. These so-called "nonantiarrhythmic drugs" such as drugs acting on the renin-angiotensin-aldosterone system, fish oil, and statins can reduce the likelihood of future ventricular tachycardia/ventricular fibrillation in patients with coronary artery disease or congestive heart failure. The role of AADs for chronic therapy for primary and secondary prevention of sudden cardiac death is problematic because of proarrhythmia and adverse side effects. Because these nonantiarrhythmic drugs are well tolerated and have no proarrhythmic actions, their benefits should outweigh risks.

Original languageEnglish
Pages (from-to)438-449
Number of pages12
JournalJournal of Cardiovascular Pharmacology
Volume55
Issue number5
DOIs
StatePublished - May 2010

Fingerprint

Anti-Arrhythmia Agents
Sudden Cardiac Death
Implantable Defibrillators
Cardiac Arrhythmias
Pharmaceutical Preparations
Ventricular Fibrillation
Ventricular Tachycardia
Mortality
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Amiodarone
Fish Oils
Primary Prevention
Renin-Angiotensin System
Secondary Prevention
Coronary Artery Disease
Heart Diseases
Shock
Heart Failure
Morbidity
Drug Therapy

Keywords

  • Antiarrhythmic drugs
  • Sudden cardiac death

ASJC Scopus subject areas

  • Pharmacology
  • Cardiology and Cardiovascular Medicine

Cite this

Antiarrhythmic and nonantiarrhythmic drugs for sudden cardiac death prevention. / Das, Mithilesh; Zipes, Douglas P.

In: Journal of Cardiovascular Pharmacology, Vol. 55, No. 5, 05.2010, p. 438-449.

Research output: Contribution to journalArticle

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